HERTFORDSHIRE COUNTY COUNCIL
Agenda Item
No:
ADULT SAFEGUARDING TOPIC GROUP
4
THURSDAY 18 MARCH 2010
Report author: Silla Haili, Hertfordshire Safeguarding Adults Board Manager
Lead officer: Sue Darker, Assistant Director for Learning Disabilities and
Mental Health
This report is provided to address the three questions as set out in the
scoping document in relation to safeguarding.
1. What is safeguarding in Hertfordshire?
2. What formal structures are in place to ensure effective safeguarding?
3. What challenges regarding safeguarding do we face in Hertfordshire?
PURPOSE OF REPORT
To provide the topic group with answers to the above mentioned questions
with the following desired outcomes in mind:


That members are satisfied with the governance arrangements in place to
ensure vulnerable adults are kept safe
Areas for future scrutiny are identified
BACKGROUND
Anyone can be a victim of abuse, but higher incidence rates are positively
correlated with the victim’s vulnerability. Periods of vulnerability can be
experienced by everyone, for example being seriously ill renders one
vulnerable, and dependency on others increases this vulnerability.
‘No Secrets’ published in March 2000 by the Department of Health set the
framework for the development of adult protection work.
It sets out guidance on developing and implementing multi-agency policies
and procedures to protect vulnerable adults from abuse and defines a
vulnerable adult as someone ‘who is or may be in need of community care
services by reason of mental or other disability, age or illness; and who is or
may be unable to take care of him or herself, or unable to protect him or
herself against significant harm or exploitation’.
In July 2009 the Department of Health published the results of an extensive
consultation on adult abuse. We are awaiting the government response (No
Secrets 2) which is likely to extend the guidance. The government response
is expected in the autumn of 2010.
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QUESTIONS
1. What is safeguarding in Hertfordshire?
Overall responsibility for safeguarding vulnerable adults in Hertfordshire rests
with the Adult Care Services department of Hertfordshire County Council,
although it is recognised that effective safeguarding against abuse can only
be done in partnership with other agencies and organisations in the county.
Hertfordshire has a well established and well regarded multi-agency
procedure (Hertfordshire Inter Agency Procedure for the Protection of
Vulnerable Adults – ACS666) to protect vulnerable adults from abuse. This
was originally drawn up in 1999 and work on a revised version is underway.
A flowchart showing how safeguarding referrals are dealt with is attached in
appendix 1.
Safeguarding activities in Hertfordshire are based on the No Secrets guidance
as well as the Association of Directors of Social Services (ADASS) National
Framework of Standards for good practice and outcomes in adult protection
work. Please see appendix 2 for the ADASS standards.
Safeguarding investigations
A safeguarding investigation will be undertaken where there is reason to
believe that a vulnerable adult has suffered, is suffering or likely to suffer
significant harm or serious exploitation. The investigation will determine:
whether the person has suffered, is suffering, or is likely to suffer such harm
or exploitation and if so, whether community care services should be provided
or arranged, or any other action taken to protect the person from such harm or
exploitation. The investigation will include any agency involved with the
individual and will include the police if criminal activity is thought to have taken
place.
Serious Concerns About Establishments
Where there are concerns about an entire service or service provider, a
serious concerns investigation is undertaken and if necessary their contract is
suspended until improvements are made. The most frequent use of a serious
concerns meeting follows a safeguarding adults from abuse investigation
concerning one vulnerable adult where concerns are raised about the care of
others in the same establishment. For example:
 A vulnerable adult dies (including death by suicide) and abuse or neglect
is known or suspected to be a factor in their death.
 A vulnerable adult has sustained a potentially life-threatening injury
through abuse or neglect is known or suspected to be a factor.
 A vulnerable adult has sustained serious and permanent impairment of
health or development through abuse or neglect.
 The care of a number of vulnerable adults causes concern about practice
standards within the home e.g. poor skin care.
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Serious concerns can also be raised by the regulatory body (the Care Quality
Commission) or through contract monitoring processes.
Housing Associations
Housing associations which provide housing related support have a contract
with HCC which obliges them to inform us of suspicions or allegations of
abuse, neglect, or exploitation. The Supporting People team in Adult Care
Services deal with allegations by either referring them to the appropriate team
(if there is social care funding going into the project) or by leading the
safeguarding process if no social care funding is involved.
Housing associations which have a contract with HCC are assessed by the
Hertfordshire Quality Assessment Framework’s Core Service Objectives.
Particularly relevant for safeguarding is section C 1.4. (Protection from Abuse)
of this framework which assesses the performance of the association against
a set of expected standards, please see appendix 3 for these. If it is found
that they are underperforming in this area, they will be issued with a clear
action plan with deadlines, stating the areas of improvement required.
Housing Associations are kept up to date with changes and requirements
regarding safeguarding by e-mail from the Supporting People Unit contract
officers, who will also forward invitations to events and training being run by
HCC and external providers. Safeguarding awareness raising events are also
held by the Principal Officer for Safeguarding in Adult Care Services and the
Children, Schools and Families safeguarding teams for housing providers. It
is also part of housing association’s contract specification that all of their staff
undertake the HCC safeguarding e-training, and this is monitored and
checked at service review by the contract and review officers.
Home care
There are currently approximately 6500 adult home care service users with 45
main home care agencies delivering services to them. All home care
agencies have a contract with the council and all are required to adhere to our
nine core service standards of which the ninth specifically addresses abuse
and exploitation, please see appendix 4 for these. If they provide live-in care,
they must also adhere to four additional service standards.
All home care agencies must also be registered by the Care Quality
Commission (CQC) and meet the statutory requirements laid down by
Government. These requirements are set out in the Care Standards Act 2000
and National Minimum Standards Regulations for agencies providing home
care services (also known as domiciliary services).
Every time an allegation is made where abuse, neglect or exploitation is
suspected by home care staff, a safeguarding investigation will commence
immediately. In addition all home care agencies are required to report any
incidences of abuse, neglect or exploitation in monthly reports that are
submitted to Service Solutions Teams in Adult Care Services; these reports
are called ‘Electronic Form 1’ or EF1 for short. From April 2009 to the end of
January 2010, seven reports of abuse were recorded on EF1 from
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commissioned home care providers. These are made available to Members
on Connect (go to A-Z, find Performance Hub under ‘P’, click on ‘ACS’ and
then follow the link for ‘Provider Statistics – home care’). This information is
also shared with the HCC Contracts Unit who is responsible for contract
monitoring.
Support for carers
It is recognised that supporting carers, is crucial to preventing abuse occurring
as a result of carer breakdown. As a preventative measure, short breaks are
offered to carers in order for them and their families to have a necessary and
valuable break from their caring responsibilities.
Short breaks are provided in a variety of ways, reflecting the varying needs of
the individual being cared for, their carers and their families and can include:
 Day care visits in community and residential units
 Outreach services provided by specialist teams and residential units
 Family based overnight and day care services
 Overnight and day sitting services
 Contracted carers
 Supported access to leisure and holiday schemes
A recent development has been the setting up of a web-based service called
Book Your Own Breaks which allows carers to log on to a web page and find
fully vetted care cover direct without having to employ care-workers, or handle
money – responsibilities which carers have told us inhibit their take up of
direct payments. In addition the service is fully accessible to people who
purchase care privately as well as those who receive support from the local
authority. The electronic system, provided by Slivers of Time, automatically
completes timesheets and administration as well as providing information
about care workers and their availability making it easy for family carers to
find a suitable match. Care workers can be booked for as little as an hour
and at short notice. They are trained and employed by Crossroads Care, a
leading charity providing support for carers. The service provides ultra-flexible
work opportunities, allowing staff to work when and where it suits them.
2. What formal structures are in place to ensure effective
safeguarding?
The Hertfordshire Safeguarding Adults Board (HSAB)
In recognition of the recommendation made by the November 2008
Commission
of Social Care Inspection (CSCI) service inspection on
safeguarding, the Hertfordshire Safeguarding Committee became a more
formal and strategic Board in September 2009.
Hertfordshire County Council has the lead responsibility for ensuring effective
arrangements for safeguarding of adults across the county. Each member of
the Hertfordshire Safeguarding Adults Board is responsible for ensuring that
effective safeguarding arrangements are in place within their agency or
organisations.
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The overarching principle guiding the Board’s work is that all people have a
right to live and work, be cared for, and be supported in an environment free
from abuse, harassment, violence or aggression. HSAB will work to ensure
that Hertfordshire is a safe place to work and live.
Board membership consists of agencies and individuals that are key to
realising effective safeguarding of adults across the county:
 Adult Care Services (ACS), Hertfordshire County Council
 Hertfordshire ACS Executive or Deputy County Councillor
 Children Schools and Families (CSF), Hertfordshire County Council
 Hertfordshire Constabulary
 NHS Hertfordshire (merger of the two Hertfordshire PCTs into one
organisation as of April 15th 2010)
 Hertfordshire Community Health Services
 East and North Hertfordshire NHS Trust
 West Hertfordshire Hospitals NHS Trust
 Hertfordshire Partnership Foundation Trust (HPFT)
 POhWER advocacy agency
 Care Quality Commission (CQC)
 Hertfordshire Probation
Please see appendix 5 for the HSAB structure chart
These organisations are required to co-operate with the local authority in the
operation of the Board and have shared responsibility for the effective
discharge of its functions. Other organisations may be consulted upon as and
when necessary.
The scope of the Board’s role includes safeguarding and promoting the
welfare of adults in three broad areas of activity:
 Preventative activity affecting all adults, aiming to identify and prevent
abuse, whilst promoting independence.
 Proactive work that aims to target particular groups of vulnerable adults,
including, for example, those ‘vulnerable’, older adults, adults in care, in
hospital, in custody, and adults with disabilities.
 Responsive work to protect adults who are at risk of suffering from, are
suffering from, or have suffered from abuse.
The Board discharges its functions through several sub groups. Each sub
group has a lead member from one of the partner organisations and
membership consists of people who sit on the Board or who have been
nominated by a Board member to sit on a sub group. The sub groups are as
follows:
Sub group 1: Policies and procedures
The aim of this sub group is to look at developing new and improving existing
policies and procedures regarding safeguarding in Hertfordshire. Currently
work is underway to revise the existing Hertfordshire Inter Agency Procedure
for the Protection of Vulnerable Adults which will include a section on serious
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case review protocol. In the coming year, work will commence on developing
new multi-agency information sharing protocols.
Sub group 2: Learning and development
Consistent training across all agencies is key to ensuring a coherent and
joined-up approach to safeguarding activities. This sub group will actively
lead the development of learning and development across Hertfordshire on
behalf of the Board. It will address areas where learning and development is
poor and ensure that changes deliver an improvement. Some key activities in
the coming year will be the development of a multi-agency competency based
learning and development framework based on individual and organisational
responsibilities for safeguarding adults as well as an assurance framework
through which to monitor the safeguarding training being provided within each
partner organisation.
Sub group 3: Communications
One of the core objectives of the Board is to raise public awareness of adult
abuse. This subgroup will undertake a wide array of activities to achieve this
ambition.
A multi-agency communications team has been set up to
coordinate this work and there are plans for the advocacy agency POhWER
to establish a service user focus group which will contribute to the strategic
direction of this work. Current activities include developing a communications
plan, with the aim of targeting specific hard-to-reach vulnerable groups, such
as BME communities, those with sensory disabilities, and those who are
isolated and do not engage in community activities. The group is also looking
at ways in which we can raise awareness of support available to carers.
Other initiatives being scoped are a dedicated safeguarding website, a hotline
number for members of the public and a generic awareness raising campaign
across the county.
Sub group 4: Mapping
For any preventative work to be effective, the Board needs to have an
understanding of what factors impact upon its work. This includes identifying
future pressure factors presented by a change in demographics, the ageing of
the population in Hertfordshire, and changes in communities. The Board also
want to gain an understanding of other vulnerable groups and their
safeguarding needs. Issues being researched here include human trafficking,
forced marriage, genital mutilation, and domestic violence to name but a few.
Research is continuously under way with an aim to produce bi-annual reports
outlining ‘the state of Hertfordshire’ as pertains to safeguarding.
Audits of safeguarding practice
As an outcome of the November 2008 CSCI (now the Care Quality
Commission, CQC), inspection Hertfordshire County Council now
commissions quarterly independent audits to assess how well the
Hertfordshire Inter Agency Procedure for the Protection of Vulnerable Adults
is being implemented operationally.
The auditor highlights the overall key strengths and improvements and
identifies areas for further improvement.
The auditor makes
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recommendations for Hertfordshire County Council and Hertfordshire
Partnership Foundation Trust to consider. The ongoing audit cycle facilitates
the monitoring of the improvements being embedded into day to day practice.
Within this audit, the cases are reported by team as there is a clear pattern of
some teams having embedded safeguarding and their standard of work being
of such a good standard that it can be used as an exemplar to support other
teams in the development of their practice. Outcomes assessed are:
 Person Safeguarded
 Policy and Procedures Implemented
 Timescales
 Multi agency involvement where appropriate
 Good quality decision making
 Good quality evidenced based recording
 Evidence of management oversight and input throughout the process
 Risk assessment adequately reflects all areas of risk to service user, and
others if necessary
 Service user involvement or representation, this must include evidence the
service user has been seen
 Clear chronological record of all actions, telephone calls, correspondence
etc in case notes.
 Quality of investigation
 Evidence of minutes being circulated
 Quality minutes of meetings.
 Protection planning
 At stage of closure a clear outcome recorded and reason why
 Clear outcome for service user and perpetrator
Internal audits of practice can also be commissioned as required.
3. What challenges regarding safeguarding do we face in
Hertfordshire?
Raising public awareness
Raising public awareness of safeguarding for vulnerable adults continues to
be a challenge. Heightened awareness of the issue would in turn alert people
to reporting abuse and therefore enable public agencies to respond
appropriately. Although this could raise pressure on service provision it is
nevertheless the position of the Board that an individual’s human rights are of
paramount importance and therefore an increase in the reporting of abuse is
to be welcomed. Regional work is currently underway to ensure safeguarding
boards are working together where possible to unite as a single voice and act
as a lobby group to central government. It is in our best interest to be seen as
a forward thinking authority which is proactive in impacting on government
legislation and guidance.
Changes in legislation and government policy
New government guidance is forthcoming this autumn, albeit a definite time
has not been confirmed. It is expected that the publication of No Secrets 2
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will bring with it new legislation which will naturally impact upon the work of
the Board. Central government have so far issued only one definite change in
legislation which is to make safeguarding adults boards a legal requirement
for all local authorities. Once we have No Secrets 2 we will be able to
ascertain the impact this will have on our work.
Information sharing
Information sharing between partner agencies has been highlighted as a
problem. This is sometimes due to technical difficulties, differing IT systems,
or confidentiality of data. HSAB recognises the need for a formal information
sharing protocol and this is on the work programme for next year.
Creating links between safeguarding of adults and children
Creating links with safeguarding children is acknowledged to be an important
part of the Board’s work. The ‘Think Family’ agenda is a government initiative
that extends the message of integration from Every Child Matters across adult
services, including health services and the police so that everyone shares
responsibility for family outcomes. Think Family is an initiative that identifies
and promotes best practice in supporting families. Its approach is centred on
encouraging and empowering frontline staff to innovate and cooperate in
response to whole-family situations. It means reforming services and systems
for vulnerable children, young people and adults to ensure that these services
work together to meet the full range of needs within each family for both adult
and child and that they strengthen the ability of family members to provide
care and support to each other and maintain the family unit.
Services of all types may come into contact with families at risk and so the
implications of Think Family are far reaching and extend to both universal and
targeted services working with adults, young people, children and families. A
Think Family project manager has been appointed and is now in post. Work is
underway to look initially at piloting this work in specific areas. There are also
two specialist parenting practitioners in post providing services in
Hertfordshire as part of this growing agenda.
Tensions between self-directed support and the Vetting and Barring
Scheme
Self-directed support is a system intended to offer service users the
opportunity to take control of and to personalise their support. It recognises
that that the person being supported is best placed to understand their own
needs and how to meet them. This system is delivered through a new
initiative called personal budgets. The person in receipt of a personal budget
can choose to employ someone to care for them as a personal assistant;
however, under current legislation they are not required to have this person
security vetted.
The Safeguarding Vulnerable Groups Act (2006) defines the scope of the
Vetting and Barring Scheme. It provides that certain activities in relation to
children and vulnerable adults are regulated. A regulated activity is any
activity which involves contact with children or vulnerable adults. This could
be paid or voluntary work.
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Such activities include:
 Any activity of a specified nature which involves contact with children or
vulnerable adults within certain periods, or overnight.
 Any activity allowing contact with children or vulnerable adults that is in a
specified place frequently or intensively.
 Fostering and childcare.
 Any activity that involves people in certain defined positions of
responsibility.
It will be a criminal offence for an employer to allow a barred person, or a
person who is not yet registered with the Independent Safeguarding Authority
(ISA), who administer the vetting and barring database, to work for any length
of time in any regulated activity.
It will be a criminal offence for an employer to take on a person in a regulated
activity if they fail to check that person’s status. However, domestic
employers (e.g. parents and carers) do not have to check that their
employees are ISA-registered but the new scheme will give them the
opportunity to check the status of an individual (with their consent) if
they wish to do so. It will be an offence for a barred person to take part
in any regulated activity in a domestic circumstance.
Naturally, this poses a dilemma for us as the authority responsible for
administering personal budgets. We are currently working together with the
Safer Staffing Team in the council to resolve this issue but it is an issue which
affects all local authorities.
Mental Capacity Act 2005
The Mental Capacity Act (2005) provides the framework for acting and making
decisions on behalf of individuals who lack the mental capacity to do these
acts or make these decisions for themselves. The starting assumption that
someone has capacity unless assessed otherwise.
This can include acts or decisions on things like how to manage money or
medication, when to get up, what to wear, what to eat, whether to go to the
doctor, and whether to seek help when something like abuse is happening to
them.
In adults safeguarding, we deal with adults who are considered to be able to
make rational choices for themselves which includes accepting help when
situations of abuse occur. However, we cannot force assistance on anyone
who does not want to accept this unless they are found to be lacking in mental
capacity. This naturally leads to a situation whereby abuse may be taking
place but the victim refuses help from the authorities. In these situations, we
can offer advice and guidance on how the person can protect themselves or
access help at a later date but of course cannot force them to do so.
The Act does state that individuals have the right to be supported in making
their own decisions with regards to their welfare and that is why raising
awareness of help available is crucial in order to reach those most vulnerable
and who find themselves in situations where they do not want to access
support.
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